Definition

Eyelid drooping is excess sagging of the upper eyelid. The edge of the upper eyelid may be lower than it should be (ptosis) or there may be excess baggy skin in the upper eyelid (dermatochalasis). Eyelid drooping is often a combination of both conditions.

The problem is also called ptosis.

Alternative Names

Ptosis, Dermatochalasis; Blepharoptosis; Third nerve palsy - ptosis; Baggy eyelids

Causes

A drooping eyelid is most often due to:

• Weakness of the muscle that raises the eyelid
• Damage to the nerves that control that muscle
• Looseness of the skin of the upper eyelids

Drooping eyelid can be:

• Caused by the normal aging process
• Present before birth
• The result of an injury or disease

Diseases or illnesses that may lead to eyelid drooping include:

• Tumor around or behind the eye
• Diabetes
• Horner syndrome
• Myasthenia gravis 
• Stroke
• Swelling in the eyelid, such as with a stye

Symptoms

Drooping may be present in one or both eyelids depending on the cause. The lid may cover only the upper eye, or the entire pupil may be covered.

Problems with vision will often be present:

• At first, just a sense that the very upper field of vision is being blocked.
• When the drooping eyelid covers the pupil of the eye, vision may become completely blocked.
• Children may tip their head back to help them see under the eyelid.
• Tiredness and achiness around the eyes may also be present.

Increased tearing despite a feeling of dry eyes may be noticed.

Exams and Tests

When drooping is on one side only, it is easy to detect by comparing the two eyelids. Drooping is more difficult to detect when it occurs on both sides, or if there is only a slight problem. Comparing the current extent of drooping with the amount shown in old photos may help you detect the progression of the problem.

A physical exam will be done to determine the cause.

Tests that may be performed include:

• Slit-lamp examination
• Tensilon test for myasthenia gravis
• Visual field testing

Treatment

If a disease is found, it will be treated. Most cases of drooping eyelids are due to aging and there is no disease involved.

Eyelid lift surgery (blepharoplasty) is done to repair sagging or drooping upper eyelids.

• In milder cases, it can be done to improve the appearance of the eyelids. 
• In more severe cases, surgery may be needed to correct interference with vision.
• In children with ptosis, surgery may be needed to prevent amblyopia, also called "lazy eye."

Outlook (Prognosis)

A drooping eyelid can stay constant, worsen over time (be progressive), or come and go (be intermittent).

The expected outcome depends on the cause of the ptosis. In most cases, surgery is very successful in restoring appearance and function.

In children, more severe drooping eyelids may lead to lazy eye or amblyopia. This may result in long-term vision loss.

When to Contact a Medical Professional

Contact your health care provider if:

• Eyelid drooping is affecting your appearance or vision.
• One eyelid suddenly droops or closes.
• It is associated with other symptoms, such as double vision or pain.

See an eye specialist (ophthalmologist) for:

• Drooping eyelids in children
• New or rapidly changing eyelid drooping in adults

References

Alghoul M. Blepharoplasty: anatomy, planning, techniques, and safety. Aesthet Surg J. 2019;39(1):10-28. PMID: 29474509 pubmed.ncbi.nlm.nih.gov/29474509/.

Cioffi GA, Liebmann JM. Diseases of the visual system. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 395.

Friedman O, Zaldivar RA, Wang TD. Blepharoplasty. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 26.

Olitsky SE, Marsh JD. Abnormalities of the lids. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 642.

Vargason CW, Nerad JA. Blepharoptosis. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 12.4.